Provider Demographics
NPI:1952512543
Name:VALENTINE, LESLEY JAYNE (LAC)
Entity Type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:JAYNE
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5131 SW 38TH PL APT 4
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-3822
Mailing Address - Country:US
Mailing Address - Phone:360-292-3220
Mailing Address - Fax:
Practice Address - Street 1:1316 NW 23RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2602
Practice Address - Country:US
Practice Address - Phone:360-292-3220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00514171100000X
WAAC60135758171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORAC00514OtherACUPUNCTURE LICENSE
ORAC00514OtherACUPUNCTURE LICENSE